Throughout the world, alcohol and substance use can be described as vectors of HIV infection. Transmission of HIV related to alcohol and substance use may be direct or indirect. Direct transmission of HIV comes through the sharing of needles or other "work" among injection drug users (IDUs), or through exposure to blood by other means, such as sharing a contaminated straw used for intranasal inhalation of cocaine. Indirect transmission occurs when substance users, often while under the influence of the substance, become vulnerable to unsafe practices, such as trading sex for drugs or money to get drugs, failure to use condoms or safer sex practices, or failure to maintain stable relationships, thus increasing the number of sexual partners, about whom they may know very little.
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